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Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban.
Journal of Stroke & Cerebrovascular Diseases ( IF 2.5 ) Pub Date : 2020-05-23 , DOI: 10.1016/j.jstrokecerebrovasdis.2020.104982
Oana M Dumitrascu 1 , Oksana Volod 2 , Swaraj Bose 3 , Yao Wang 3 , Valérie Biousse 4 , Patrick D Lyden 1
Affiliation  

We report a case of ophthalmic artery occlusion (OAO) in a young patient with COVID-19 infection that was on therapeutic anticoagulation with apixaban for deep venous thrombosis (DVT).

A 48-year-old man with obesity was hospitalized with a severe form of COVID-19 infection, complicated with acute respiratory failure, septic shock, dilated cardiomyopathy and fungemia. Despite treatment with prophylactic enoxaparin (initial D-Dimer 1.14 µg/ml FEU (normal < 0.05 µg/ml FEU), D-Dimer increased to above 20 µg/ml FEU and patient continued to spike high fevers. This prompted further investigations and upper and lower extremities DVTs were confirmed and managed with enoxaparin 1 mg/kg twice daily. D-dimer level decreased to 4.98 µg/ml FEU while on therapeutic anticoagulation. Three weeks later pending hospital discharge, the anticoagulation was switched to oral apixaban 10 mg twice daily. Patient developed acute severe right eye visual loss of no light perception and was diagnosed with incomplete OAO. D-Dimer was elevated at 2.13 µg/ml FEU. Stroke etiological work-up found no embolic sources, resolution of the dilated cardiomyopathy and negative antiphospholipid antibodies. Treatment was changed to enoxaparin and no thrombotic events were encountered to date.

Ocular vascular complications have not yet been reported in COVID-19. Controversy exists on the best management algorithm for the hypercoagulable state associated to COVID-19 Either direct oral anticoagulants or low-molecular-weight-heparin are considered appropriate at discharge for patients with venous thromboembolism. The optimum regimen for ischemic stroke prevention and the significance of D-Dimer for anticoagulation monitoring in COVID-19 remain unclear.



中文翻译:

服用阿哌沙班的 COVID-19 患者出现急性眼动脉闭塞。

我们报告了一名年轻的 COVID-19 感染患者出现眼动脉闭塞 (OAO) 的病例,该患者正在接受阿哌沙班抗凝治疗以治疗深静脉血栓 (DVT)。

一名 48 岁肥胖男性因严重的 COVID-19 感染住院,并伴有急性呼吸衰竭、感染性休克、扩张型心肌病和真菌血症。尽管使用预防性依诺肝素治疗(初始 D-二聚体 1.14 µg/ml FEU(正常 < 0.05 µg/ml FEU)),D-二聚体增加至 20 µg/ml FEU 以上,患者继续发高烧。这促使进一步调查和上报。确认了 DVT 并用依诺肝素 1 mg/kg 每日两次进行治疗。在抗凝治疗期间,D-二聚体水平降至 4.98 µg/ml FEU。三周后等待出院,抗凝治疗改为口服阿哌沙班 10 mg 两次每天。患者出现急性严重右眼视力丧失,无光感,被诊断为不完全性 OAO。D-二聚体升高至 2.13 µg/ml FEU。中风病因检查未发现栓塞来源,扩张型心肌病消退,阴性抗磷脂抗体。治疗改为依诺肝素,迄今为止未遇到血栓事件。

尚未有 COVID-19 引起眼部血管并发症的报道。对于与 COVID-19 相关的高凝状态的最佳管理算法存在争议,对于静脉血栓栓塞患者出院时,直接口服抗凝剂或低分子量肝素被认为是合适的。预防缺血性卒中的最佳方案以及 D-二聚体在 COVID-19 抗凝监测中的意义仍不清楚。

更新日期:2020-05-23
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